=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801184171
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURIE ELISABETH SCHEIDLE PSY.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2011
-----------------------------------------------------
Last Update Date | 07/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 626 REVOLUTION ST
-----------------------------------------------------
City | HAVRE DE GRACE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21078-3320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-939-8744
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 626 REVOLUTION ST
-----------------------------------------------------
City | HAVRE DE GRACE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21078-3320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-939-8744
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 04879
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------